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Covariation of changing patent ductus arteriosus management and preterm infant outcomes in Pediatrix neonatal intensive care units

Journal of Perinatology volume 41, pages 2526–2531 (2021)Cite this article

Subjects

Abstract

Objective

To test the hypothesis that NICU-specific preterm infant outcomes co-vary with changes in local patent ductus arteriosus (PDA) management.

Study design

This retrospective multicenter study examined NICU-specific aggregated data for infants born 400–1499 g (VLBW) in the Pediatrix Clinical Data Warehouse. For each NICU and each year 2006–2016 we calculated proportion of infants receiving cyclooxygenase inhibitor (COXI) and/or PDA ligation and determined NICU-specific changes in these therapies between consecutive years. We examined relationships between NICU-specific changes in COXI/ligation and concurrent changes in local adjusted in-hospital outcomes.

Results

In 5678 observations of change at 259 NICUs summarizing 78,105 infants, between-year decreases in NICU-specific proportion treated with COXI/ligation were associated with concurrent increases in local mortality and decreases in BPD among infants 400–749 g, and with decreased pulmonary hemorrhage in larger infants.

Conclusions

NICU-specific adjusted mortality, BPD, and pulmonary hemorrhage rates co-vary with changes in local COXI/ligation rates in some VLBW infant subgroups.

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Fig. 1: Derivation of study cohort.
Fig. 2: Unadjusted trends in NICU-specific rates of COXI use, age at initial COXI dose, PDA ligation, and age at PDA ligation, by birth weight.
Fig. 3: Unadjusted trends in NICU-specific rates of studied clinical outcomes, by birth weight.
Fig. 4: Adjusted associations between NICU-specific, weight-specific changes in PDA treatment and concurrent changes in local outcomes.

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Author information

Authors and Affiliations

  1. Division of Neonatology, Connecticut Children’s, Hartford, CT, USA

    James I. Hagadorn

  2. Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA

    James I. Hagadorn

  3. Division of Biostatistics and Bioinformatics, Penn State College of Medicine, Hershey, PA, USA

    Michele L. Shaffer

  4. Department of Statistics, University of Washington, Seattle, WA, USA

    Michele L. Shaffer

  5. Department of Neonatology, Baylor University Medical Center, Dallas, TX, USA

    Veeral N. Tolia

  6. Pediatrix Medical Group, Baylor Scott & White Health, Dallas, TX, USA

    Veeral N. Tolia

  7. Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA

    Rachel G. Greenberg

  8. Duke Clinical Research Institute, Durham, NC, USA

    Rachel G. Greenberg

Authors
  1. James I. Hagadorn
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  2. Michele L. Shaffer
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  3. Veeral N. Tolia
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  4. Rachel G. Greenberg
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Contributions

JIH performed statistical analysis and drafted the manuscript; MLS consulted regarding statistical analysis and reviewed and revised the manuscript; VNT reviewed and revised the manuscript; RGG performed statistical analysis and reviewed and revised the manuscript; and all authors approved the contents of the final manuscript.

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Correspondence to James I. Hagadorn.

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Hagadorn, J.I., Shaffer, M.L., Tolia, V.N. et al. Covariation of changing patent ductus arteriosus management and preterm infant outcomes in Pediatrix neonatal intensive care units. J Perinatol 41, 2526–2531 (2021). https://doi.org/10.1038/s41372-021-01170-y

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